Provider Demographics
NPI:1073917266
Name:MCCONAGHY HOME MEDICAL, LLC
Entity Type:Organization
Organization Name:MCCONAGHY HOME MEDICAL, LLC
Other - Org Name:MCCONAGHY HOME MEDICAL / GROVE HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONAGHY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-275-3964
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:179-A SOUTH JACKSON STREET
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-0789
Mailing Address - Country:US
Mailing Address - Phone:251-275-3964
Mailing Address - Fax:251-275-4310
Practice Address - Street 1:179A S JACKSON ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3009
Practice Address - Country:US
Practice Address - Phone:251-275-3964
Practice Address - Fax:251-275-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X, 332BC3200X, 332BP3500X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7462410001Medicare NSC